State report faults Exeter Hospital in hepatitis C outbreak

Exeter Hospital ignored employee concerns about a medical technician accused of infecting patients with hepatitis C, had an unreliable system for documenting their complaints and told at least one not to file a report, according to a public health department report released yesterday.

The Division of Public Health Services report follows a yearlong investigation into the outbreak, which started in May 2012. While the hospital’s past failures in safeguarding controlled drugs have come to light previously, the report includes new details of how it handled co-worker complaints about David Kwiatkowski, along with broad information about the people he’s accused of infecting.

Kwiatkowski, a former medical technician who has been jailed since his arrest in July 2012, is accused of stealing painkiller syringes from the hospital’s cardiac catheterization lab and replacing them with saline tainted with his blood. He has pleaded not guilty to 14 federal drug charges and is scheduled to go to trial in January.

Thirty-two Exeter Hospital patients have been diagnosed with the strain of hepatitis C that Kwiatkowski carries, along with an additional person who contracted the liver-destroying disease from one of them. In the other states where Kwiatkowski worked, there have been seven confirmed cases in Maryland, six in Kansas and one in Pennsylvania.

As outlined in earlier court documents, Kwiatkowski’s co-workers raised concerns that he sometimes showed up for work with bloodshot eyes, was seen sweating profusely and foaming at the mouth and sometimes slurred his speech. But the hospital did not follow its own policy and re-test him for drugs, the report states.

“Significant concerns of drug use by (Kwiatkowski), raised by co-workers, were not investigated,” the report concludes.

That prompted a strong objection from Exeter Hospital President Kevin Callahan. In a letter to public health director Dr. Jose Montero, he said the report includes many false statements and conclusions and is unfair to the health care professionals whose work in noticing a cluster of hepatitis C cases led to Kwiatkowski’s arrest.

“Exeter Hospital investigated whether David Kwiatkowski was fit for duty when any concern was raised,” Callahan said, noting that Kwiatkowski always offered a plausible explanation for his appearance. “The reality is that he was a skilled con man who duped health care professionals in seven states before landing at Exeter Hospital.”

According to the report, while the hospital had an online system for reporting suspected drug misuse, it didn’t work well. One worker said a complaint got lost after being filed. Another said her supervisor told her not to file a report about Kwiatkowski, according to the report.

A hospital spokesman said those claims contradict the hospital’s findings.

Investigators, in reviewing the hospital’s drug oversight practices, found that employees were free to go in and out of the cardiac lab’s procedure room without being restricted or documented, even if they weren’t assigned to a particular case. In 11 of the confirmed cases, Kwiatkowski was not assigned to the patient but was in the room, and in three cases he was there even though he was not scheduled to be working that shift.

The report contains new information about the 32 infected patients, 21 men and 11 women ages 43 to 83. Two were from outside New Hampshire – one from Maine and one from Massachusetts. Seven of them reported experiencing higher than usual pain during their procedures, indicating they were given saline instead of painkillers.

The report’s recommendations focus on three main areas: the creation of comprehensive systems to prevent and detect drug diversion, increased regulation of medical technicians and other health care workers, and improved communication between hospitals and state officials.